WE all know that this paper was a real solid one..concerning the importance given to embroyology,nephro and cns with a very less repeated q,lets have a discussion of these q..cooperation from all is needed.

a child presented with respiratory distress after birth, was given surfactant but could not improve . his female sibling died at one month of age due to respiratory distress in the same hospital.what is the diagnosis?
1.transposition of great vessels

mycosis fungoides marker?
1.cd3
2.cd1
3.cd56a
4.

Langerhans cell marker
Cd 68
Cd3
Cd

a third gravida lady with a history of two second trimester abortion presented with funneling of cervix os ...?m/n
1.mc Donald stricture

questions we r rememebring but its also important we analyse the tends of AIIMS and all india.
how did u feel the paper was with just 2 as it is repeats from last recent three papers ....expected was 50...what do u think all india pre pg will be like ?

which of the following does not have cicatricial alopecia?
a)lupus vulgaris
b)DLE
c)alopecia areata

MMR is number of maternal deaths per 1000.10000,,100000,....
Egg on side appearance
floating lilly sign on X ray chest
retroceacal appendicitis, which maneuver causes pain ..flexion of hip, ext of hip.
Next investigation in a child who has not passed meconium for 48 hrs and has vomitted and has abdominal distension.... manometry,,, Barium images of lower GIT..

which does not occur in ulnar nerve injury?
a)claw hand
b)atrophy of hypothenar eminence
c)loss of sensation of medial one third of hand
d)adduction of thumb[/b]

Kanaval's sign Passive extension of the digits produces pain on the dorsum of the hand Tenosynovitis .

Change in Function (Decreased Range of Motion)
Decreased Finger Range of Motion
Decreased range of motion of the fingers suggests arthritides, fracture, and collateral ligament sprain (look for medial or lateral PIP swelling). Flexion tenosynovitis can present with intermittent "locking" (trigger finger), tenderness over the palmar tendons, and a snap or click on flexion and extension. For diffuse tenosynovitis, check Kanavel's sign. (As a reminder of this and other unique hand findings, see Table 2.)

Table 2. Hand Findings: Alphabetic Listing of Unique Signs
Name of the Sign or Test Description Positive Finding Interpretation
Dubois' sign Very short pinky Suggests congenital syphilis
Eichhoff-Finkelstein's sign Have the patient make a fist over his opposed thumb and then flex and ulnarly deviate the fist Pain over the anatomic snuffbox or production of a painful click Thumb dysfunction from De Quervain's tenosynovitis
Froment's sign Have the patient pinch a piece of paper between the thumb and the radial aspect of the forefinger If you can pull out the paper, Froment's sign is present Ulnar nerve weakness
Fuller Albright's sign Have the patient make a fist Dimpled fourth knuckle Foreshortened fourth metacarpal bone, which suggests pseudohypoparathyroidism
Grind test Grasp the patient's thumb and (gently) grind it like a peppermill Pain Osteoarthritis of the thumb
Gubler's sign Fusiform swelling of the dorsal wrist Suggests chronic lead poisoning
Kanaval's sign Passive extension of the digits produces pain on the dorsum of the hand Tenosynovitis
Maisonneuve's sign Extreme hyperextension of the hand Suggests a Colle's fracture
Millan's sign Lilac discoloration along the free edge of the fingernail Possible syphilis
"OK" sign Have the patient make an "OK" sign by opposing the thumb and forefinger to make a ring. Check the strength of the "O" by trying to open it with your fingers. Tests integrity of the median nerve Weakness indicates median nerve abnormality
Pastia's sign Pink or red transverse lines along the wrists, antecubital fossa, or groin that remain hyperpigmented Suggests scarlet fever
Plotz's sign Lack of ability to fold hands in prayer position Possible rheumatoid arthritis of the carpal joints
Schamroth's sign Have the patient place both forefinger nails together and look between them If you can see a small diamond space between them, then the nails are not clubbed. No diamond space, then clubbing is present. Many pulmonary, cardiac, and gastric conditions can cause clubbing. See text. Hyperthyroidism can also cause clubbing.
Steinert's sign Have the patient make a fist over his or her opposed thumb If the thumb extends beyond the base of the little finger, the test is positive Possible Marfan's syndrome
Wartenberg's finger sign Abduction of the fifth finger Suggests ulnar nerve palsy
Watson's stress test Pinch the patient's hand between your thumb at the anatomic snuffbox and your forefinger at the palmar base of the thumb, and as you radially deviate the wrist, release your forefinger If you feel a click with your thumb, the test is positive Scapholunate sprain or dislocation
Wrist sign Significant overlap of the thumb and pinky when grasping the opposite wrist Possible Marfan's syndrome

All voluntary muscles of the head region are derived from paraxial mesoderm
(somitomeres and somites), including musculature of the tongue, eye (except
that of the iris, which is derived from optic cup ectoderm), and that associated
with the pharyngeal (visceral) arches. Patterns of muscle formation
in the head are directed by connective tissue elements derived from neural
crest cells.

child presented with respiratory distress after birth, was given surfactant but could not improve . his female sibling died at one month of age due to respiratory distress in the same hospital.what is the diagnosis?
1.transposition of great vessels

all are included in learning except
1. response
2.catharsis
3.exposure

worst outcome in pregnancy is eissenmeinger syndrome

the dangerous area of the eyeball

a. ciliary body
b. retina
c. optic nerve
d. sclera

staging of bone tumor is done by
TNM staging

FRACTIONAL EXCRETION OF Na

FENa is an accurate screening test for differentiating prerenal failure versus acute tubular necrosis. A value below 1 percent suggests prerenal disease, as the physiologic response to a decrease in renal perfusion is an increase in sodium reabsorption to control hypovolemia. Values above 2 percent usually indicate acute tubular necrosis: either excess sodium is lost due to tubular damage, or the damaged glomeruli result in hypervolemia resulting in the normal response of sodium wasting. Values between 1 and 2 may be seen in either disorder. In renal tract obstruction, values may be either higher or lower than 1%

Que.20 3 year old girl posted for tonsillectomy, found to have midline cystic swelling which is painless below the hyoid. What should be done next
1) Surgery
2) X-ray chest
3) antibiotics
4) Aspiration

Que.21 After laparoscopic appendicectomy, patient had fall from bed on her nose, after whish she had swelling in the nose and slight difficulty in breathing. What should be done next
1) Antibiotics for 7 to 14 days and discharge
2) Intravenous antibiotics for 7-10 days
3) Surgical drainage
4) Observation in hospital for 2wks

Que.45 a child presents with non blanching rash over the extensor aspect of arm with swelling over knee urine analysis show proteinurea 1 + and rbc 3+ on kidney biopsy which finding will be seen
1) fusion of podocytes
2) ATN
3) depositions of Ig A
4)thickening of membrane

Que.90 On post mortem of a new born, kidney shows radial cysts. Which of the following finding would be associated with this condition
1) imperforate anus
2) hepatic cysts with fibrosis
3) absent ureters
4) â€¦

This technique is particularly suitable for lower third oesophageal carcinomas where the tumour can be dissected under direct vision from the abdomen. Reconstruction has conventionally been with a gastric pull-up, although a colonic tube is an alternative conduit. Most commonly, the conduit is pulled from the abdomen through the narrow posterior mediastinum into the neck by tying it to a catheter, swab or length of latex tubing. This can be a difficult stage of the operation, especially when the gastric/colonic conduit is bulky. Consequently, there is the potential to devascularise the conduit at this stage. The incidence of conduit ischaemia has been reported to be 10%.

pleurocentesis doesnt pierce transversus thoracis, as it lies in the ant aspect (The tranversus thoracis lies internal to the thoracic cage, anteriorly. It is a thin plane of muscular and tendinous fibers, situated upon the inner surface of the front wall of the chest. It is in the same layer as the subcostal muscles.

It arises on either side from the lower third of the posterior surface of the body of the sternum, from the posterior surface of the xiphoid process, and from the sternal ends of the costal cartilages of the lower three or four true ribs )

The gallbladder has a simple columnar epithelial lining characterized by recesses called Aschoff's recesses, which are pouches inside the lining .

pt wid cutaneous angiomas,tumor of pancreas,parathyroid has
A) MEN1
B) MEN2A
C) MEN 2B
D)MEN 2 C
NOW FOR ANS.....MEN 1 AS PANCREAS INVLVMNT IS XCLUSIV TO MEN1 SOME FRNDS TOLD ME BT MEN 2B AS IT HAS CUTANEOUS INVLVMNT BUT DEN DERE IS NO PANCREAS INVLVMT......also in my defence dere is lichen cutaneous amyloidosis in MEN 2b NT ANGIOMAS AS IN QUES..... I MITE BE WRONG AS WELL....PLEASE CORRECT ME

ondansetron, granisetron, dolasetron, and palonosetron. The first three agents (ondansetron, granisetron, and dolasetron, Figure 63â€“6) have a serum half-life of 4â€“9 hours and may be administered once daily by oral or intravenous routes. All three drugs have comparable efficacy and tolerability when administered at equipotent doses. Palonosetron is a newer intravenous agent that has greater affinity for the 5-HT3 receptor and a long serum half-life of 40 hours.

Agenesis of the corpus callosum is a relatively frequent malformation. Its prevalence in the general population is unknown because it might occur in a totally asymptomatic manner. Its prevalence in a population with mental retardation reaches 2% to 3%. Agenesis of the corpus callosum represents approximately 50% of the malformations of the midline.

Agenesis of the corpus callosum can be partial (affecting in most cases the posterior portion, except when it is associated with holoprosencephaly) or complete. The lateral ventricles are deformed by the fibers of the cerebral hemispheres that were destined to form the corpus callosum and that form the Probst bundles running longitudinally along the lateral ventricles. The Probst bundles are inconsistently present, and their presence has been considered a sign of better prognosis.

Corpus callosum agenesis can be associated with other brain malformations (such as neuronal migration disorders) or with extracerebral malformations. In the presence of associated malformations, the prognosis of agenesis of the corpus callosum is considered poor in most cases. In contrast, the prognosis of isolated agenesis of the corpus callosum (partial or complete) is much more variable, with some cases having a totally normal or near-normal neurologic outcome,[/b] some cases with moderate or severe neurologic handicap, and some cases evolving toward death within the first days or months after birth. Because of the relatively low number of reported cases and the relatively short follow-up in many of these cases, providing reliable figures for the neurologic outcome of the isolated malformation remains difficult.

Agenesis of the Corpus Callosum-
Agenesis of the corpus callosum consists of a heterogeneous group of disorders that vary in expression from severe intellectual and neurologic abnormalities to the asymptomatic and normally intelligent individual
When agenesis of the corpus callosum is an isolated phenomenon, the patient may be normal, whereas individuals with neurologic symptoms, including mental retardation, microcephaly, hemiparesis, diplegia, and seizures.

Nelson Textbook of Pediatrics 17th edition Pg-1988

When the entire corpus callosum is destroyed by tumor or surgical section, the language and perception areas of the left hemisphere are isolated from the right hemisphere. Patients with such lesions, if blindfolded, are unable to match an object held in one hand with that in the other. Objects placed in the right hand are named correctly, but not those in the left. Furthermore, if rapid presentation is used to avoid bilateral visual scanning, such patients cannot match an object seen in the right half of the visual field with one in the left half. They are also alexic in the left visual field, since the verbal symbols that are seen there and are projected to regions of the right hemisphere have no access to the language areas of the left hemisphere. If given a verbal command, such patients will execute it correctly with the right hand but not with the left; if asked to write from dictation with the left hand, they will produce only an illegible scrawl.

The patient with a lesion of the splenium of the corpus callosum or the adjacent white matter cannot read or name colors because the visual information cannot reach the left language areas. There is, however, no difficulty in copying words; presumably the visual information for activating the left motor area crosses the corpus callosum more anteriorly. Spontaneous writing and writing to dictation are also intact because the language areas, including the angular gyrus, Wernickeâ€™s and Brocaâ€™s areas, and the left motor cortex, are intact and interconnected, but after a delay, the patient is unable to read what he has previously written (unless it was memorized). This is the syndrome of alexia without agraphia

A lesion that is limited to the anterior third of the corpus callosum (or a surgical section of this part, as in patients with intractable epilepsy) surprisingly does not result in an apraxia of the left hand. A section of the entire corpus callosum does result in such an apraxia, i.e., a failure of only the left hand to obey spoken
commands, the right one performing normally, indicating that the fiber systems that connect the left to the right motor areas cross in the corpus callosum posterior to the genu (but anterior to the splenium). Object naming and matching of colors without naming them are also done without error. However, blinded, the patient cannot name a finger touched on the left hand or use it to touch a designated part of the body.

Classic abnormalities include sinus tachycardia; new-onset atrial fibrillation or flutter; and an S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III,Often, the QRS axis is greater than 90. T-wave inversion in leads V1 to V4,

Ref- Harrisons 16th Ed Pg-1562

The ECG in pulmonary embolism.

80 consecutive hospitalized CCU patients with acute PE, all underwent pulmonary angiography
Excluded 12 pts with “a history of cardiopulmonary disease that could have modified the ECG”
Finding Percentage of patients with EKG finding

T waves negative V1-V4 68%
S1 Q3 T3 pattern 50%

Peripheral low voltage 29%

Sinus tachycardia 26%

Complete/incomplete RBBB 22%

Pulmonary P wave 5%

Normal 9%

In massive PE (determined angiographically), anterior ischemic pattern was noted in 85% of patients versus 19% in nonmassive PE; no other parameter correlated with severity

Anterior T-wave inversions has a sensitivity of 85%, specificity of 81%, PPV of 93%, and a NPV of 65% for massive PE in patients w/ suspected PE.
ref-http://medicine.ucsf.edu/housestaff/Chiefs_cover_sheets/EKGinPE.pdf

.Which of the following does not come under GREIVOUS HURT,
a.injury to one kidney
b.injury to one testis c.facial abrasions
d.injury to one eye

ref:ESSENTIALS OF Forensic MEDICINE AND TOXICOLOGY,REDDY,25/E pg.252.

ans. GRIEVOUS INJURY comes under S.320,I.P.Cdefined as "any of the following injuries are grievous,
-Emasculation.
-permanent privation of sight of either eye.
-permanent privation of hearing of either ear.
-privation of any member or joint
-destruction or permanent impairing of the power of any joint or member
-permanent disfiguration of the head or face.
-fracture or dislocation of a bone or tooth
-any hurt which endangers life or which causes the victim to be in severe bodily pain or unable to follow his ordinarily pursuits for a period of 20 days.
-so ans-------->c.

After aspirating the cell into the tip of the micropipette, the tip was broken off and the contents expelled into an Eppendorf tube containing RNasin (0.5 ml). Single-stranded cDNA was generated by reverse transcription SuperScript II RNase H-reverse transcriptase (Invitrogen) with oligo(dT) primer (Invitrogen) following the manufacturer's protocol. The PCR was carried out by using 5 ml of cDNA template, 10Â´ PCR buffer (5 ml), MgCl2 (3 ml; 25 mM), dNTPs (1 ml; 10 mM), primers (1 ml each; 25 mM), AmpliTaq polymerase (0.5 ml; 5 units/ml; Applied Biosystems), and DEPC-treated water for a final volume of 50 ml. To observe siRNA-mediated reduction of TRPM7 expression, 35 cycles were run at the optimal annealing temperature for each primer set (57Â°C for TRPM7), and then the annealing temperature was decreased by 0.5Â°C each cycle for a total of 45 cycles.

Intensive Management Intensive diabetes management has the goal of
achieving euglycemia or near-normal glycemia. This approach requires
multiple resources including thorough and continuing patient
education, comprehensive recording of plasma glucose measurements
and nutrition intake by the patient, and a variable insulin regimen thatmatches glucose intake and insulin dose. Insulin regimens usually include
multiple-component insulin regimens, multiple daily injections
(MDI), or insulin infusion devices (each discussed below).
because it may prolong the period of C-peptide production,
which may result in better glycemic control and a reduced risk of
serious hypoglycemia.
Although intensive management confers impressive benefits, it is
also accompanied by significant personal and financial costs and is
therefore not appropriate for all individuals. Circumstances in which
intensive diabetes management should be strongly considered arelisted in Table 323-10.

as i remember the question was which does not need intensive insulin therapy and not intensive care.

The psoas sign indicates an irritative focus in proximity to that muscle. The test is performed by having patients lay on their left side as the examiner slowly extends the right thigh, thus stretching the iliopsoas muscle. The test is positive if extension produces pain. Similarly, a positive obturator sign of hypogastric pain on stretching the obturator internus indicates irritation in the pelvis. The test is performed by passive internal rotation of the flexed right thigh with the patient supine.

5-HT1D/1B Agonists & Migraine Headache
The 5-HT1D/1B agonists (triptans) are used almost exclusively in migraine headache. Propranolol, amitriptyline, and some calcium channel blockers have been found to be effective for the prophylaxis of migraine in some patients. They are of no value in the treatment of acute migraine. The anticonvulsants valproic acid and topiramate have recently been found to have good prophylactic efficacy in many migraine patients. Flunarizine, a calcium channel blocker used in Europe, has been reported in clinical trials to effectively reduce the severity of the acute attack and to prevent recurrences. Verapamil appears to have modest efficacy as prophylaxis against migraine.

Acridine orange is a nucleic acid selective fluorescent cationic dye useful for cell cycle determination. It is cell-permeable, and interacts with DNA and RNA by intercalation or electrostatic attractions. When bound to DNA, it is very similar spectrally to fluorescein, with an excitation maximum at 502 nm and an emission maximum at 525 nm (green). When it associates with RNA, the excitation maximum shifts to 460 nm (blue) and the emission maximum shifts to 650 nm (red). The dye is often used in epifluorescence microscopy.

Acridine orange is prepared from coal tar and creosote oil.
Acridine orange can be used in conjunction with ethidium bromide to differentiate between live and apoptotic cells.

reddy 19th edition page 297(sorry guys i have old edition but you can look in mechanical aspyxia chapter after throttleing there is a topic on dissection of neck)

the neck structure should be dissected in situ and in a bloodless feild.th block removal of neck structures may produce artefacts in the neck tissues which resemble bruises.when the tongue and neck structures are firmly grasped and pulled upon, the hyod bone may be fractured.Bruising invariably occurs in throttling and is very important in the absence of external marks and fracture of the neck structures.to obtain bloodless field in the neck, the head should be opend and the brain removed as in routine autopsy. The abdominal and throacic organs should be removed as in routine autopsy.then an incision should be made from the chin to the manubrrium sterni and the platysma dissected laterally on both sides.

so you can see that to obtain bloodless field neck is opened last.

REF:ESSENTIALS OF Forensic MEDICINE AND TOXICOLOGY,REDDY,25/E;pg.
DISSECTION OF THE NECK IN ASPHYXIA.
-The neck structures shud be dissected insitu and in a 'bloodless field'.
-The block removal of neck structures as in "routine" autopsies may produce artefacts in the neck tissues which resemble bruises.also when the tongue and neck structures are firmly grasped and pulled upon,the hyoid bone maybe fractured.so these maybe confused with bruising and fracture of hyoid bone which occurs d/t throttling.
-To obtain a BLOODLESS field in the neck ,the head should be opened and the brain removed as in routine autopsy-so HEAD is opened FIRST.
-Next the abdominal and thoracic organs shud be removed as also in routine autopsy.
-Then the head is slowly moved up aand down and allowed to drain of blood.
-Then an incision is made from the chin to the manubrium sterni or a V-shaped incision made on the neck and the platysma dissected laterally on both sides.
-If the veins are damaged they shud be ligated to prevent bleeding ,as otherwise the blood will infiltrate into the tissues and maybe mistaken for contusions.
-The sternomastoid muscles are cut from their attachments.
-The CCA is cut longitudinally looking for any bruising around the bifurcation.Tears around the intima of the carotid artery are usually seen 1/2 to 1 cm below the bifurcation of the vessels.
-hyoid bone is identified and the suprahyoid an infrahyoid muscles are reflected noting for any contusion
-Also the thyroid cartilage,larynx,trachea are all examined for any fractures.
-finally the spinal cord is exposed and examined